Schizophrenia Flashcards
Classification
2 main systems for classification of mental disorder.
DSM5- one positive symptom must be present
ICD10- two ore more negative symptoms, also recognises sub types
Positive symptoms
Atypical symptoms experienced in addition to every day experiences.
Hallucinations- Sensory experiences of stimuli that have no basis in reality or are distorted perceptions of what is there
Delusions- Irrational beliefs that have no basis in reality e.g. believing they are the victim of a conspiracy
Negative symptoms
Atypical symptoms which represents the loss of a usual experience
Avolition- loss of motivation to carry out tasks which leads to reduced activity
Speech poverty- reduction in quality and frequency of speech. Verbal responses may be delayed
Diagnosis and classification
Reliability (eval)
IRR is the extent to which different assessors agree. For diagnosis this is the extent to which mental health professionals arrive at the same diagnosis for the same patients. Cheniaux et al had 2 psychologists independently diagnose patients using ICD or DSM criteria. IRR was poor. One diagnosed 26 (DSM) and 44 (ICD). The other diagnosed 13 (DSM) and 24 (ICD).
Diagnosis and classification
Validity (eval)
Criterion validity is used to assess the validity of a diagnosis (do different assessment systems arrive at the same diagnosis for the same patient). Cheniaux et al found schizophrenia is much more likely to be diagnosed using ICD. Thai suggests it is over diagnosed in ICD or under diagnosed in DSM.
Diagnosis and classification
Co-morbidity (eval)
When 2 or more conditions occur together. If conditions often occur together this questions their validity as they may not be separate. Buckley et al concluded 50% of patients diagnosed with schizophrenia also diagnosed with depression, 47% substance abuse, 29% PTSD and 23% OCD. This challenges that classification and diagnosis of schizophrenia. For diagnosis, if half the patients are also diagnosed with depression we could just be bad at telling the difference between conditions. For classification, if severe depression looks like schizophrenia they’d be better seen as a single condition. This makes diagnosis/ classification confusing.
Diagnosis and classification Symptom overlap (eval)
Schizophrenia and bipolar include negative symptoms like avolition and positive symptoms like delusions. This questions the validity of classification and diagnosis. Under ICD a patient could be diagnosed as schizophrenic however the same symptoms under DSM criteria could lead to a diagnosis of bipolar. This suggests they may not even be separate conditions.
Psychological explanations
Family dysfunction
Schizophrenogenic mother (Fromm-Reichmann) Noted that many of her patients spoke about a particular type of parent. schizophrenogenic mother is cold, rejecting, controlling and creates an atmosphere characterised by secrecy and tension. Leads to distrust, paranoid delusions and schizophrenia.
Double-bind theory (Bateson et al)
Emphasised the role of communication style in the family. Child fears doing the wrong thing and receives mixed messages about how to behave. when they get it wrong they are punished by withdrawal of love. They see the world as confusing and dangerous which is reflected in symptoms like disorganised thinking and paranoid delusions.
Expressed emotion
level of negative emotions expressed to a patient by their carer. Includes verbal criticism, hostility and emotional over involvement. Causes high stress levels which can lead to relapse or trigger onset in vulnerable.
Psychological explanations
Cognitive explanation
Focus on mental processes such thinking, language and attention. Schizophrenia is associated with abnormal information processing.
Metarepresentation is the cognitive ability to reflect on thoughts and behaviours and allows insights into intentions and goals. Also allows us to interpret the actions of others. Dysfunction would disrupt out ability to recognise actions as our own which explains hallucinations of voices and delusions.
Central control is the cognitive ability to suppress automatic responses while performing deliberate actions instead. disorganised speech and thought disorder can result if unable to suppress automatic thoughts and speech triggered by other thoughts.
Psychological explanations
Positives
Support for family dysfunction as a risk factor
Read et al reviewed studies of child abuse and schizophrenia. 69% of adult women in-patienst diagnosed had a history of physical abuse, sexual abuse, or both in childhood. For men it was 59%. Adults with insecure attachments are also more likely to have schizophrenia.
Evidence for dysfunctional info processing
Stirling et al compared the ability of schizophrenia patients with controls on cognitive tasks including the Stroop Test. Patients took over twice as long to complete the task last he controls, suggesting they process info differently.
Psychological explanations
Negatives
Family dysfunction as a risk factor
A weakness of this is data was collected after the development of symptoms, which may have distorted recall. This lowers validity.
Dysfunctional info processing
Links between symptoms and faulty cognitions are clear but it doesn’t show the origins of the cognitions or schizophrenia. Cognitive theories can explain proximal causes (what causes current symptoms) but not distal causes (how the condition originated).
Biological therapies
Atypical antipsychotics
Used since 1970s, developed to maintain or improve on the effectiveness of drugs in suppressing symptoms and minimising side effects.
Clozapine was developed but was withdrawn after leading to a blood condition. It was found to be more effective than typical antipsychotics so is still used when other treatment fails. People taking it have regular blood tests to ensure they aren’t developing the condition.
Clozapine binds to dopamine receptors, but also acts on serotonin and glutamate receptors. this helps reduce depression and anxiety, improving cognitive functioning. This means clozapine is often used on patients at risk of suicide, which is common among schizophrenia sufferers.
Risperidone is a more recently developed atypical antipsychotic. It was developed to be as effective as clozapine without the side effects. It binds more strongly to dopamine receptors so is more effective in smaller doses than most antipsychotics.
Psychological therapies
CBT
takes 5-20 sessions, helps patients identify irrational thoughts and try to change them. discuss how likely they are to be true, and consider alternatives. doesnt get rid of symptoms but makes them easier to cope with.
Helps by making sense of where their delusions and hallucinations come from and how they impact feelings/behaviour. Psychological explanations help reduce anxiety and challenging delusions helps patients learn they aren’t bad on reality.
Biological therapies
Positives
Evidence for effectiveness at tackling symptoms
Thornley et al (typical)
Reviewed studies where chlorpromazine was compared to a placebo. Chlorpromazine was associated with better overall functioning and reduced symptom severity. Relapse was also lower.
Meltzer
Concluded clozapine is more effective than typical antipsychotics, and is effective in around 40% of cases where typical antipsychotics failed.
Biological therapies
Negatives
Side effects
typical- associated with dizziness, agitation, sleepiness, weight gain, and itchy skin. Long term use can result in a condition caused by dopamine super sensitivity which leads to involuntary facial movements. It can also block dopamine action in the hypothalamus leading to NMS which is a potentially fatal condition.
atypical- developed to reduce side effects. can lead to a blood condition so patients taking clozapine have regular blood tests to check for any early signs.
